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Flight Paramedic Certification > High Risk OB > Flashcards

High Risk OB Flashcards

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1
Q

What is Dilation?

A

Extent of cervical dilation from 1-10cm

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2
Q

What is Effacement?

A

Percent of thickness of the cervix. Normally 2 cm thick and thins during labor. When thinned to 1 cm patient is 50% effaced.

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3
Q

What is Lie?

A

Longitudinal orientation of fetus in relation to longitudinal orientation of mother.

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4
Q

What is Station?

A

Fetal head in relation to mother’s pubic bone and is expressed as - or + number in cm.

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5
Q

What is Presentation?

A

What is attempting to emerge first? Cephalic, Breech, or Shoulder.

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6
Q

What are baseline Fetal Heart Tones?

A

120-160 /min

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7
Q

What is the single most important predictor of fetal well being?

A

1 cause of poor variability is fetal hypoxia

Variability (should be between 10-15 bpm)

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8
Q

What causes poor variability?

A

Fetal hypoxia
Smoking
Sedatives/analgesics administered to mom Extreme prematurity
Fetal sleep.

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9
Q

What are Accelerations?

A

Usually associated with fetal movement and CNS response to stimuli.
Usually good, Hypoxic fetus with metabolic acidosis cannot accelerate the heart.

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10
Q

Early Decelerations

A

Typical vasal response to squeezing of the head caused by strong contractions.
Usually ok if occurring at same time as contractions.

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11
Q

Late Decelerations

A

Indicate uteroplacental insufficiency causing fetus to experience a hypoxic bradycardia.
BAD

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12
Q

What are Late Decelerations commonly associated with?

A

Pregnancy induced hypertension
Diabetes
Smoking
Late deliveries

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13
Q

Variable Decelerations

A

Cord compression commonly occurring during contractions.
Look for cord problems (prolapse, short, entanglement, nuchal).
Typically V or W shaped waveforms on monitor.

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14
Q

What is Shouldering?

A

Deceleration followed by a short Acceleration to compensate.

Good thing!

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15
Q

Sinusoidal variation

A

Typical of Fetal hypovolemia or anemia.

Caused by accidental tap of umbilical cord during amniocentesis, fetomaternal transfusion, or placental abruption.

Very Bad

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16
Q

Fetal Heart Rate Bradycardia

A

<120 for 5-10 minutes

Most common cause is hypoxia

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17
Q

Fetal Heart Rate Tachycardia

A

> 160 for >10 minutes

Most common cause is maternal fever (sepsis)

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18
Q

Factors contributing to fetal distress (6)

A

Hypertonic or tetanic contractions (Discontinue oxytocin)
Rule out cord prolapse
Assure fetal oxygenation (Give mom high flow O2)
Maternal hypotension (250-500 ml bolus)
Placental abruption (Trauma, bleeding)
Change positions (Left lateral recumbent)

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19
Q

S/S of imminent delivery

A 
Vaginal bleeding
Contractions less than Q10
Increasing intensity of contractions
Urge to push
Crowning
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20
Q

Preterm Labor Tocolytics

A 
Terbutaline (0.25 mg SQ Q15)
Magnesium Sulfate (4-6G bolus over 15 min, 2 G/hr drip)
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21
Q

S/S of Magnesium Toxicity and treatment

A

Decreased deep tendon reflexes
Decreased BP
Decreased LOC
Respiratory depression

Give calcium chloride, push fluids to cause diuresis

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22
Q

Ectopic Pregnancy

A

Every woman of child bearing age with acute abdominal complaints is an ectopic pregnancy until proven otherwise.
Cross match blood, Give Rhogam if mom is RH-

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23
Q

Who is most at risk for Pregnancy induced hypertension?

A

African American Females

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24
Q

Signs of pre-eclampsia

A

Hypertension
Proteinuria
Edema

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25
Q

HELLP syndrome

A

Hemolysis
Elevated Liver enzymes
Low Platelet count

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26
Q

Eclampsia Treatment

A

Give Diazepam PRN for seizure activity with MgSo4 (Magnesium Sulfate)

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27
Q

What causes Abdominal Aortic Aneurysm in pregnancy?

A

50% of women under 40 with AAA are pregnant. Gravid uterus increases pressure on distal aorta and femoral arteries.

28
Q

Trauma in Pregnancy

A

Maximize fetal viability in trauma by aggressive treatment of mom.

Can lose 30-35% of blood volume before hypovolemia presents.

Seatbelt placement causes abruptio placenta.

29
Q

What is Placenta Previa?

A

Placenta attached over cervical opening.

Often presents with painless bright red vaginal bleeding.

30
Q

Common causes of Placenta Previa?

A

Uterine scarring
Multiparity with short intervals
Post D/C

31
Q

Treatment of Placenta Previa

A

High flow O2, IV fluids
Consider tocolytics and blood products
Assess contractions, fetal movement, fetal heart tones, and hemorrhage.

32
Q

What is Placenta Abruptio?

A

Tearing of uterine wall and placenta vasculature

33
Q

S/S of Placenta Abruptio

A

“Ripping or tearing pain” with Dark blood or no evidence of blood loss.

Can cause exsanguination and Placental insufficiency.

Blood irritates uterus and will cause contractions.

34
Q

Treatment of Placenta Abruptio

A

High flow O2, IV fluids
Consider tocolytics and blood products
Assess contractions, fetal movement, FHT
Watch for DIC.

35
Q

Uterine rupture treatment

A

Serial fundal height measurements, rapid transfer, oxytocin 20-40 units in 1000ml @ 125hr.

36
Q

What is a Nuchal cord?

A

Cord is wrapped around neck.

Causes Variable Decelerations.

37
Q

Treatment of Nuchal cord

A

Focus on relieving cord tension before next contraction. Try to gently loosen and draw down over head, clamp and cut before shoulders are delivered if it is too tight to remove.

38
Q

Treatment of cord prolapse

A

Elevate presenting part off the cord with a hand in the vagina to prevent cord compression.

Place patient in knee to chest position.

Consider tocolytics to reduce pressure on the cord during contractions.

39
Q

Breech presentation

A

True breech=butt first
Footling breech = foot first (do not attempt to deliver)
Fetus should not be touched until the umbilicus has spontaneously delivered.

40
Q

Treatment of Breech presentation

A

Mauriceau’s maneuver.
Insert fingers into vagina to create airway for baby, after shoulders have been delivered, rotate baby’s trunk so that the back is anterior and apply gentle downward traction while another provider applies suprapubic pressure.

41
Q

When to suction meconium

A

Suction mouth, posterior pharynx and nose after delivery of head but before shoulders.

If baby is not vigorous, suction mouth and trachea with ETT.

42
Q

Define vigorous neonate

A

Strong respiratory efforts,
Good muscle tone
Heart rate greater than 100.
Normal first APGAR is 8-9.

43
Q

What does APGAR stand for?

A 
Activity (active)
Pulse (>100)
Grimace (response to stimuli)
Appearance (pink)
Respirations (vigorous cry)
44
Q

Post-partum hemorrhage treatment

A

Vigorous fundal massage
Rapid infusion of Oxytocin 20-40u /1000 ml
Methergine 0.2mg IM
Bimanual uterine compression

45
Q

Uterine inversion treatment

A

Manual replacement is the uterus has not yet contracted down and cervix has not constricted. Do not remove placenta.

46
Q

3 ways to confirm preterm rupture of amniotic membranes

A

Positive nitrazine testing of fluid
Pooling of fluid in vaginal vault
Positive ferning on microscopic slide

47
Q

During pregnancy, maternal cardiac output increases by ___.

A

2 L/min

48
Q

During pregnancy, maternal plasma volume increases by ___.

A

40%

49
Q

Placenta has a very high concentration of ____.

A

Tissue thromboplastin

50
Q

Why do pregnant females have difficulty breathing?

A

Functional residual capacity is decreased by 20%

Increased blood volume causes capillary engorgement causing airway swelling

51
Q

Initial treatment of preterm rupture of amniotic membranes

A

IV fluids

Left lateral decubitus position

52
Q

Contraindications of Terbutaline

A 
Maternal pulse greater than 120
Insulin-dependent diabetes
Chronic hypertension
Active hemorrhage
Chorioamnionitis (intra-amniotic infection)
53
Q

What maneuver may be used to help deliver an infant with shoulder dystocia?

A

McRobert’s maneuver. Knees to chest with gentle downward traction.

54
Q

Complications associated with breech presentation (6)

A 
Cord prolapse
Cord entanglement
Cord compression
Head entrapment
Fetal birth trauma
Birth asphyxia
55
Q

Emergency C-Section indications

A 
Multiple decelerations with poor rate / variability 
Sustained Bradycardia (<120 BPM for >10 minutes)
Sinusoidal waveform
56
Q

What is the most common cause of preterm labor?

A

Hypovolemia

57
Q

Anaphylactoid syndrome of pregnancy

A

Caused by maternal exposure to fetal cells.

DIC and Anaphylaxis at the same time

58
Q

Treatment of Anaphylactoid syndrome

A

Fluid resuscitation
Increase PEEP
FFP, Platelets, Cryo

59
Q

1 cause of maternal death

A

Trauma

60
Q

1 cause of fetal death

A

Maternal death

61
Q

“Stomach as hard as a board”

“Fetal parts presenting under the mother’s skin”

A

Uterine rupture!

62
Q

True or false: If a mother is Rh negative, Always give Rhogam

A

True

63
Q

When to give Rhogam

A

28 weeks gestation
After delivery
After any trauma / bleeding / potential bleeding

64
Q

Common cause of newborn seizures

A

Hypoglycemia

65
Q

Gestational diabetic mothers are more likely to give birth to children with ____.

A

Hypoglycemia

Flight Paramedic Certification (15 decks)

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